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Development of a compassion-focused and contextual behavioural environment and validation of the Therapeutic Environment Scales (TESS).Veale, David; Miles, Sarah; Naismith, Iona; Pieta, Maria; Gilbert, Paul; King's College London; University of Derby (Cambridge University Press, 2016-01-02)Aims and method The aims of the study were to develop a scale sensitive enough to measure the interpersonal processes within a therapeutic environment, and to explore whether the new scale was sensitive enough to detect differences between settings, including a community based on compassionate mind and contextual behaviourism. The Therapeutic Environment Scales (TESS) were validated with 81 participants in three different settings: a specialist service for anxiety disorders, a specialist in-patient ward and a psychodynamic therapeutic community. Results TESS was found to be reliable and valid. Significant differences were seen between the services on the dimensions of compassion, belongingness, feeling safe, positive reinforcement of members' acts of courage, extinction and accommodation of unhelpful behaviours, inconsistency and high expressed emotion. These processes were over time associated with improved outcomes on a specialist service for anxiety disorders. Clinical implications The TESS offers a first step in exploring important interpersonal relationships in therapeutic environments and communities. An environment based on a compassionate mind and contextual behaviourism offers promise for the running of a therapeutic community.
A new therapeutic community: Development of a compassion-focussed and contextual behavioural environmentVeale, David; Gilbert, Paul; Wheatley, Jon; Naismith, Iona; King's College London; University of Derby; Institute of Psychiatry; King's College London and the South London and Maudsley NHS Foundation Trust; London UK; Mental Health Research Unit; Kingsway Hospital; Derby UK; Institute of Psychiatry; King's College London and the South London and Maudsley NHS Foundation Trust; London UK; Institute of Psychiatry; King's College London and the South London and Maudsley NHS Foundation Trust; London UK (Wiley, 2014-04-14)Social relationships and communities provide the context and impetus for a range of psychological developments, from genetic expression to the development of core self-identities. This suggests a need to think about the therapeutic changes and processes that occur within a community context and how communities can enable therapeutic change. However, the ‘therapeutic communities’ that have developed since the Second World War have been under-researched. We suggest that the concept of community, as a change process, should be revisited within mainstream scientific research. This paper briefly reviews the historical development of therapeutic communities and critically evaluates their current theory, practice and outcomes in a systematic review. Attention is drawn to recent research on the nature of evolved emotion regulation systems, the way these are entrained by social relationships, the importance of affiliative emotions in the regulation of threat and the role of fear of affiliative emotions in psychopathology. We draw on concepts from compassion-focussed therapy, social learning theory and functional analytical psychotherapy to consider how members of a therapeutic community can be aware of each other’s acts of courage and respond using compassion. Living in structured and affiliative-orientated communities that are guided by scientific models of affect and self-regulation offers potential therapeutic advantages over individual outpatient therapy for certain client groups. This conclusion should be investigated further. Copyright © 2014 John Wiley & Sons, Ltd.